Abstract
BackgroundImpairments of selective control of joint movements can have consequences for many activities of daily life, but there are only a few interventions to improve selective voluntary motor control (SVMC). We have developed a treatment option to specifically enhance SVMC exploiting the advantages of interactive computer play technology. It targets SVMC by training selective activation of a muscle or a selective joint movement while it provides immediate feedback about involuntary muscle activations/movements at an (unwanted) joint. This study aims to investigate the effectiveness of this game-based intervention to enhance SVMC in children and youth with upper motor neuron lesions.MethodsWe will conduct a randomized, non-concurrent, multiple baseline design study. Patients aged between 6 and 20 years with reduced SVMC due to an upper motor neuron lesion will be included. During the baseline phase of random length, participants will attend their regular intensive rehabilitation program, and in the intervention phase, they will additionally complete 10 therapy sessions (à 40 min) of the game-based SVMC training. The primary outcome will be a short SVMC assessment conducted repeatedly throughout both phases, which quantifies movement accuracy and involuntary movements. Changes in clinical SVMC measures, muscle strength, cortical excitability, motor control of the inhibited/unwanted movement, and functional independence will be assessed as secondary outcomes. We will use a mixed-effect model to determine the change in the course of the primary outcome when the intervention is introduced, and we will compare changes between phases for secondary outcomes with paired tests.DiscussionThis study will provide first evidence whether SVMC can be improved with our game-based training. The single-case design takes into account the individualization required for this intervention, and it can help to address the challenges of intervention trials in our setting.Trial registrationGerman Clinical Trials Register: DRKS00025184, registered on 28.04.2021.
Highlights
Impairments of selective control of joint movements can have consequences for many activities of daily life, but there are only a few interventions to improve selective voluntary motor control (SVMC)
Reduced SVMC can manifest in impaired motor control and a multitude of involuntary movements, i.e., unintended movements that co-occur with the performance of a voluntary task [3]
Follow-up data will be analyzed by paired comparisons (t-test or robust alternative) between post-intervention and follow-up assessments and between the measurement directly before the intervention and at follow-up. This protocol paper describes the design of a randomized multiple baseline single-case design study to investigate the effectiveness of a novel game-based intervention to improve SVMC in children with upper motor neuron lesions
Summary
Impairments of selective control of joint movements can have consequences for many activities of daily life, but there are only a few interventions to improve selective voluntary motor control (SVMC). Reduced SVMC can manifest in impaired motor control and a multitude of involuntary movements, i.e., unintended movements that co-occur with the performance of a voluntary task [3] These include mass flexion/extension patterns and synergies of muscle activation (i.e., obligatory grouped multi-joint movements) or mirror movements (i.e., simultaneous identical movements on the contralateral side) [4, 5]. These involuntary muscle activations and movements after a lesion to the upper motor neuron are addressed to different neurophysiological origins. The occurrence of mirror movements is thought to involve bilateral cortical activation due to insufficient interhemispheric inhibition and spared ipsilateral corticospinal projections [6]
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